立体定向手术与内科治疗中小量基底核区脑出血的对比研究

目的探讨立体定向手术治疗中小量基底核区脑出血病人的疗效。方法回顾性分析82例中小量基底核区脑出血病人的临床资料,以立体定向手术抽吸结合尿激酶引流治疗为立体定向治疗组(n=41),采用内科保守治疗为内科治疗组(n=41),比较2组病人发病后30 d瘫痪侧肢体运动功能和90 d格拉斯哥预后评分(glasgow outcome scale,GOS)情况。结果立体定向治疗组病人血肿消散时间为(3.3±1.5)d,内科治疗组为(24.0±7.3)d,两组血肿消散时间存在显著差异(P<0.01)。立体定向治疗组中发病后30 d运动功能预后好者和发病后90 d GOS 5分者均明显多于内科治疗组(均P<0.05)。结论对于血肿量≤30 ml的基底核区脑出血、瘫痪侧肢体肌力为1~3级的病人,应首选立体定向手术治疗。

A comparative study of stereotactic surgery and medical treatment for small-and moderate-volume basal ganglial hemorrhage

Objective To investigate the therapeutic effect of stereotactic surgery on small-and moderate-volume basal ganglial hemorrhage.Methods Clinical data of 82 patients with small-and moderate-volume basal ganglial hemorrhage were analyzed retrospectively.The 41 patients treated by stereotactic aspiration combined with instillation of urokinase were set as stereotactic group and 41 patients treated by medical management as medical group.Motor function of the paralytic limbs 30 days after hemorrhage and GOS scores 90 days after hemorrhage were compared between the two groups.Results The dissipation time of hematoma was 3.3±1.5 d in stereotactic group and 24.0±7.3 d in medical group,and there was a significant difference in the dissipation time of hematoma between the two groups（P 0.01）.The number of patients who had good prognosis of motor function and GOS scores of 5 points was more in stereotactic group than in medical group（both P 0.05）.Conclusions Stereotactic surgery should be considered as the first choice for basal ganglial hemorrhage patients with volume equal to and less than 30 ml and the muscle strength of grade 1 to 3 in the paralytic limb.